Headache types, work up and attitudes toward treatment among Pakistani patients

Background: Headache is one of the most common neurological symptoms as ranked by World Health Organization. Data is scarce regarding headache presentation, types, diagnostic work up and treatment among Pakistani headache patients. Objective: The aim of this study was to characterize headache patients with regard to classification, presentation and attitudes toward treatment among Pakistani patients. Methods: Prospective data collection at three centers in Pakistan during 2009 and 2010. Headache classification was based on International classification of headache disorders (ICHD-2). Diagnosis was confirmed by a neurologist trained in headache diagnosis and treatment. Data was collected on a pre specified questionnaire and included demographics, pattern and presentation of headache, diagnostic work up and treatment patterns among patients. Results: A total of 970 patients included in study. Mean age of patients was 33 + 14 years. Out of these 683(70%) were women. Duration of headache was less than one month in 63)6%), 1-3 months in 61(6%), 4-6 months in 73(7%), 7-12 months in 150(15%), 1-10 years in 392 (39%), 11-20 years in 75(7.7%) and more than 20 years in 35(3.6%) patients. A worsening of headache symptoms within last one year was reported in 289(29%) patients. Frequency of headaches as reported by patients were constant (279; 29%), daily (221; 23%), 2-3 times a week (253; 26%) and 3-4 times a month (124; 13%) while 93(10%) had infrequent headache. 289 (29%) were extremely worried about their headache, 38(3.9%) believed that they had a brain tumor, 286 (29%) related it to stress. During one year period, 267 (27%) saw only one doctor, 264(27%) consulted two doctors and 409 (43%) were seen by three or more doctors for their headache. 414 943%) patients had a close family member with history of headache. 98 (10%) visited a hospital emergency room for severe headache. A CT /MRI scan was done in 34(3.5%) patients. All scans were reported normal. Migraine; 487 (52%) was most common type with 39 (4%) were Migraine with aura, 12 (1.5%) were migraine with complications while 436 (45%) were Migraine without aura. Other common headache types included Tension type headache; 350(37%), Mixed Migraine and TTH; 58(6%), Cluster headache; 8(1%). Only 13 (1.5%) patients were receiving Triptans, 118 (13%) were taking migraine prophylaxis, 167 (18%) were taking injectables for recurrent severe headaches while rest were taking Paracetamol or various non steroidal analgesics. Conclusion: Migraine and tension type headaches are most common headache types. More than 52% patients had daily or constant headache. Majority of patients with Migraine were not receiving Triptans or migraine prophylaxi